Anesthesia

Protein C Deficiency

01/07/2009

Question:

My 32 year old sister was recently diagnosed with Protein C Defiency after 2 blood clots in the same leg. To be safe I decided to be tested and also tested positive. I am 22, and have no children yet. Is it true that when taking Heparin, you can`t have an epidural during labor? Also, should my husband and I have our children before I hit 30?

Answer:

Gareth Kantor, MD

It's true that you probably can't have an epidural if you're taking heparin at that time. The concern is that the anticoagulant effect of the heparin increases the chance of an epidural hematoma. This is a blood clot in the epidural space which can compress the spinal cord and may lead to paralysis. But because heparin is an anticoagulant, it is normally stopped immediately prior to delivery, otherwise a lot of bleeding may occur. Depending on the type of heparin used, if a period of 8 - 12 hours has elapsed, and coagulation studies are normal, it may be safe to proceed with an epidural. After delivery of the baby and placenta, assuming there is not excessive bleeding, the heparin can be resumed. Decisions should be made in consultation between your anesthesiologist, your obstetrician, and a hematologist. The interaction between Protein C deficiency, which increases the risk of blood clots, and pregnancy, is something that will require expert input.

Anne Matthews, RN, PhD

In regard to getting pregnant before you reach 30, I am not aware of any reason that someone with protein C deficiency would need to have children before they reach 30. From a genetic standpoint in general, we usually suggest that considering pregnancy before the age of 35 is best as women who are older (advanced maternal age) than 35 are at an increase risk to have pregnancies with chromosome problems (such as Down syndrome). Also, it may be harder to get pregnant when someone is in her 40's.

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